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General NPI Number Information
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NPI Number | 1225575855
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA PODIATRY LLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 590 S ENOTA DR NE STE 1A
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City | GAINESVILLE
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State | GA
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Zip | 30501-2433
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Country | US
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Telephone | 470-252-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 590 S ENOTA DR NE STE 1A
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City | GAINESVILLE
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State | GA
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Zip | 30501-2433
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Country | US
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Telephone | 470-252-5756
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | PURVI SHAAN SHAH
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Credential | DPM
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Telephone | 470-439-0324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001208
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License Number State | GA
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